Healthcare Provider Details

I. General information

NPI: 1710832977
Provider Name (Legal Business Name): NITALIA TAYLOR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

878 S LAKE DR STE B
LEXINGTON SC
29072-3716
US

IV. Provider business mailing address

PO BOX 632659
CINCINNATI OH
45263-2659
US

V. Phone/Fax

Practice location:
  • Phone: 828-484-8398
  • Fax:
Mailing address:
  • Phone: 828-484-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018198
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP056321T
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: